The Comparison of Safety Between Early and Late Oral Feeding Following Ileostomy Closure (Reversal) in Relation to Post-Operative Anastomotic Leak

Abstract

Background: Ileostomy closure is a common surgical procedure performed to restore intestinal continuity following temporary diversion, yet postoperative management—particularly the timing of oral feeding—remains controversial due to concerns about anastomotic leakage and gastrointestinal dysfunction. Emerging evidence suggests early enteral feeding may enhance recovery without compromising safety, but data specific to ileostomy reversal remain limited. Objective: To compare the safety and clinical outcomes of early versus late oral feeding following ileostomy closure, with a focus on postoperative anastomotic leakage and recovery parameters. Methods: A randomized controlled trial was conducted at Sandeman Provincial Hospital, Quetta, including 198 patients aged ≥14 years undergoing ileostomy reversal. Participants were randomly assigned to early feeding (within 24 hours postoperatively) or late feeding (after bowel function return). Outcomes measured included anastomotic leakage, time to bowel motility, duration of hospital stay, complications, and discharge readiness. Statistical analysis was performed using chi-square and t-tests with p < 0.05 considered significant. Results: No anastomotic leaks occurred in either group. Early feeding significantly reduced time to first flatus (2.9 ± 0.5 vs. 4.6 ± 0.7 days, p < 0.001) and hospital stay (5.2 ± 1.1 vs. 8.3 ± 1.4 days, p < 0.001) without increasing complication rates. Conclusion: Early oral feeding after ileostomy closure is safe, accelerates gastrointestinal recovery, and reduces hospitalization without increasing anastomotic risk